     <script type="text/javascript">
		var number_of_visa	=	'<?php echo $para_step1['number_visa'];?>';
		var	type_visa		=	'<?php echo $para_step1['type_visa'];?>';	
    </script>
<div id="inner">
        <div class="wrap">
            <div id="main">    
				<div id="custom-care-block" class="custom-care-widget custom-care-on-top">
					<div class="supporter-info info">
						<a href="https://livechat.boldchat.com/aid/527608051372187996/bc.chat?cwdid=4557253158656694009" target="_blank" onclick="window.open((window.pageViewer && pageViewer.link || function(link){return link;})(this.href + (this.href.indexOf('?')>=0 ? '&' : '?') + 'url=' + escape(document.location.href)), 'Chat527608051372187996', 'toolbar=0,scrollbars=1,location=0,statusbar=0,menubar=0,resizable=1,width=640,height=480');return false;" class="live-chat"><img src="<?php echo base_url();?>public/client/img/livechat.png" alt="Live chat" /></a>
						<p>Custom Care</p>
						<p class="info-name">Ms Jenny Garden</p>
					</div>

					<div class="tel-info info">
						<p class="tel"><span>Tel:</span> +84 985 245</p>
						<p class="hotline"><span>Hotline:</span> +84 34 542 123</p>
					</div>

					<div class="email-info info">
						<span>Email: </span>
						<a href="mailto:support@govietnamvisa.com">support@govietnamvisa.com</a>
					</div>
				</div><!-- end #custom-care-center -->
				
                <div id="content">
                    <div id="step1" class="apply-form step">
                        <div class="step-nav">
                            <h1>Apply online</h1>
                        </div><!-- end .step-nav -->

                        <form action="<?php echo base_url();?>step_2" method="post" class="stepform" id="formID">
                            <div class="applicant-detail">
                                <h2>Applicant details</h2>
                                <div class="journey-info">
                                    <div class="arrival-date">
                                        <label>Date of arrival*</label><br />
                                        <input type="hidden" class="validate[dateArrivalRequired, arrivalDateRange[arrivalGroup]] text-input datepicker" id="arrival_date_hid" value="<?php echo date('m/d/Y');?>"  name="arrival_date_hid" />
                                        <input type="text" class="validate[dateArrivalRequired, arrivalDateRange[arrivalGroup]] text-input datepicker" id="arrival_date" readonly="readonly" value="" name="arrival_date" />
                                    </div>

                                    <div class="exit-date">
                                        <label>Date of exit*</label><br />
                                        <div id="exit_floor">
                                        	<input type="hidden" class="validate[dateExitRequired, exitDateRange[exitGroup]] text-input datepicker" id="exit_date_floor" value="" name="exit_date_hid_floor" />
                                        </div>
                                        	<input type="text" class="validate[dateExitRequired, exitDateRange[exitGroup]] text-input datepicker" id="exit_date" value="" readonly="readonly" name="exit_date" />
                                        <div id="exit_ceiling">
                                        	<input type="hidden" class="validate[dateExitRequired, exitDateRange[exitGroup]] text-input datepicker" id="exit_date_ceiling" value="" name="exit_date_hid_ceiling" />
                                        </div>
                                    </div>

                                    <div class="arrival-airport">
                                        <label>Arrival airport*</label><br />
                                        <select name="arrival_port" id ="arrival_port" class="validate[arrivalPortRequired]">
                                            <option value="">Select...</option>
                                            <option value="Hanoi">Hanoi (Noibai)</option>
                                            <option value="Hochiminh-Saigon">Hochiminh-Saigon (Tan Son Nhat)</option>
                                            <option value="Danang">Danang</option>
                                        </select>
                                    </div>

                                    <div class="flight-number">
                                        <label>Flight number</label><br />
                                        <input type="text" name="flight_number" value="" />
                                    </div>
                                </div><!-- end .journey-info -->
								
								<?php for($i = 1; $i <= $para_step1['number_visa']; $i++){?>	
	                                <div id="applicant1" class="applicant">
	                                    <span class="applicant-icon">Applicant <?php echo $i;?></span>
	                                    <span class="abs-arrow"></span>
	                                    <div class="applicant-input">
	                                        <div class="line">
	                                            <div class="fullname">
	                                               <label for="">Full name*</label>
	                                               <span class="tooltip" title="Exactly as it appears on the passport"><img src="<?php echo img_link('icon_help.png', 'client');?>" title="" alt="" class="" id="fullname_note_<?php echo $i;?>" /></span><br/>
	                                               <input type="text" name="full_name_<?php echo $i;?>"  id="full_name_<?php echo $i;?>" class="validate[fullNameRequired] text-input" />
	                                            </div>
	                                            <div class="date-of-birth">
	                                                <label>Date of birth*</label><br />
	                                                <select class="validate[birthMonthRequired] input-month" name="birth_mm_<?php echo $i;?>" id="birth_mm_<?php echo $i;?>" >
	                                                	<option value="">Month</option>
	                                                	<?php for($j=1; $j<=12; $j++){?>
	                                                    	<option value="<?php echo $j;?>"><?php echo date('F',mktime(0,0,0,$j,'20','1990'));?></option>
	                                                    <?php }?>
	                                                </select>
	                                                <select class="validate[birthDateRequired] input-day" name="birth_dd_<?php echo $i;?>" id="birth_dd_<?php echo $i;?>" >
	                                                	<option value="">Day</option>
	                                                	<?php for($j=1; $j<=31; $j++){?>
	                                                    	<option value="<?php echo $j;?>"><?php echo $j;?></option>
	                                                    <?php }?>
	                                                </select>
	                                                <select class="validate[birthYearRequired] input-year" name="birth_yyyy_<?php echo $i;?>" id="birth_yyyy_<?php echo $i;?>" >
	                                                <option value="">Year</option>
	                                                	<?php for($j=date("Y")-1;$j>=1921;$j--){?>
	                                                    	<option value="<?php echo $j;?>"><?php echo $j;?></option>
	                                                    <?php }?>
	                                                </select>
                                            	</div>
	                                            <div class="nationality">
	                                                <label for="">Nationality*</label><br />
	                                                <?php if(count($country)>0){?>
														<select name="nationality_<?php echo $i;?>" class="validate[nationalityRequired]" id="nationality_<?php echo $i;?>">
															<option value="">Select...</option>
															<?php foreach ($country	as $k => $v){?>
																<option value = "<?php echo $v->name;?>"><?php echo $v->name;?></option>
															<?php }?>
														</select>
													<?php }?>
	                                            </div>
	                                        </div><!-- end .line -->
	
	                                        <div class="line">
	                                            <div class="passport-no">
	                                                <label for="">Passport Number*</label><br/>
	                                                <input type="text" name="passport_number_<?php echo $i;?>" value="" id="passport_number_<?php echo $i;?>" class="validate[passportRequired,custom[onlyLetterNumber]] text-input" />
	                                            </div>
	                                            <div class="expiration-date">
	                                                <label>Passport Expiration Date*</label>
	                                                <span class="tooltip" title="Validate at least 6 months from arrival date"><img src="<?php echo img_link('icon_help.png', 'client');?>" title="" alt="" class="" id="expiration_note_<?php echo $i;?>" /></span>
	                                                <br />
	                                                <div id="error_<?php echo $i;?>"></div>
	                                                <select class="validate[expirationMonthRequired] input-month" name="expiration_mm_<?php echo $i;?>" id="expiration_mm_<?php echo $i;?>" >
	                                                	<option value="">Month</option>
	                                                	<?php for($j=1; $j<=12; $j++){?>
	                                                    	<option value="<?php echo $j;?>"><?php echo date('F',mktime(0,0,0,$j,'20','1990')); ?></option>
	                                                    <?php }?>
	                                                </select>
	                                                <select class="validate[expirationDateRequired] input-day" name="expiration_dd_<?php echo $i;?>" id="expiration_dd_<?php echo $i;?>">
	                                                	<option value="">Day</option>
	                                                	<?php for($j=1; $j<=31; $j++){?>
	                                                    	<option value="<?php echo $j;?>"><?php echo $j;?></option>
	                                                    <?php }?>
	                                                </select>
	                                                <select class="validate[expirationYearRequired] input-year" name="expiration_yyyy_<?php echo $i;?>" id="expiration_yyyy_<?php echo $i;?>">
	                                                	<option value="">Year</option>
	                                                	<?php for($j=date("Y"); $j<=2030; $j++){?>
	                                                    	<option value="<?php echo $j;?>"><?php echo $j;?></option>
	                                                    <?php }?>
	                                                </select>
                                            	</div>
	                                            <div class="gender">
	                                                <label for="">Gender*</label><br />
	                                                <select name="gender_<?php echo $i;?>">
														<option value="male">Male</option>
														<option value="female">Female</option>
													</select>
	                                            </div>
	                                        </div><!-- end .line -->
	                                        <div class="clearfix"></div>
	                                    </div><!-- end .applicant-input -->
	                                </div><!-- end #applicant1 -->
                                <?php }?>
                            </div><!-- end .applicant-detail -->

                            <div class="contact-info">
                                <h2>Contact information</h2>
                                <div class="contact-request">
                                    <label for="special-request">Special request</label><br/>
                                    <textarea rows="15" cols="100" name="message" id="special-request"></textarea>
                                </div>

                                <div class="contact-input">
                                    <p>
                                        <label for="ctac-name">Full name*</label><br/>
                                        <input type="text" name="fullname_contact" value="" id="fullname_contact" class="validate[fullNameRequired] text-input" />
                                    </p>
                                    <p>
                                        <label for="ctac-phone">Contact Phone*</label><i> (ex: +084 168 671 4663)</i><br/>
                                        <input type="text" name="phone_contact" value="" id="phone_contact" class="validate[phoneRequired,custom[phone]]  text-input" />
                                    </p>
                                    <p>
                                        <label for="ctac-email">Email*</label><i> (ex: abc@gmail.com)</i><br/>
                                        <input type="text" name="email_contact" value="" id="email_contact" class="validate[emailRequired,custom[email]] text-input"  />
                                    </p>
                                    <p>
                                        <label for="email_conf">Confirm Email*</label><br/>
                                        <input type="text" name="confirm_email_contact" value="" width="200" id="confirm_email_contact" class="validate[confirmEmailRequired,equals[email_contact]] text-input"  />
                                    </p>
                                    <p>
                                        <label for="ctac-country">Nationality*</label><br />
                                        <select class="validate[nationalityRequired]" name="nationality_contact" id="ctac-country" >
                                            <option value="">Please select</option>
                                            <?php foreach($country as $k => $v){?>
                                            	<option value="<?php echo $v->name;?>"><?php echo $v->name;?></option>
                                        	<?php }?>
                                        </select>
                                    </p>
                                </div>
                            </div><!-- end .contact-info -->
                            <div class="hidden-info">
                            	<input type="hidden" value="<?php echo $para_step1['type_visa'];?>" name="hidden_type_visa" />
                            	<input type="hidden" value="<?php echo $para_step1['number_visa'];?>" name="hidden_number_visa" />
                            	<input type="hidden" value="<?php echo $para_step1['rush_services'];?>" name="hidden_rush_service" />
                            	<input type="hidden" value="<?php echo $para_step1['purpose'];?>" name="hidden_purpose" />
                            	<input type="hidden" value="<?php echo $cus_id;?>" name="hidden_cus_id" />
                            </div><!-- end .hidden-info -->
                            <div class="submitwrap">
                                <input type="submit" class="step1-submit step-submit submit" value="Next step 2 &raquo;" />
                            </div>
                        </form>
                    </div><!-- end #step1 -->
                </div><!-- end #content -->
            </div><!-- end #main -->
        </div><!-- end .wrap -->
        <div class="clearfix"></div>
    </div><!-- end #inner -->
   
